Metabolic trajectories of diabetic ketoacidosis onset described by breath analysis

Mo Awchi; Kapil Dev Singh; Sara Bachmann Brenner; Marie-Anne Burckhardt; Melanie Hess; Jiafa Zeng; Alexandre N Datta; Urs Frey; Urs Zumsteg; Gabor Szinnai; Pablo Sinues

doi:10.3389/fendo.2024.1360989

Metabolic trajectories of diabetic ketoacidosis onset described by breath analysis

Front Endocrinol (Lausanne). 2024 May 1:15:1360989. doi: 10.3389/fendo.2024.1360989. eCollection 2024.

Authors

Mo Awchi^{1

2}, Kapil Dev Singh^{1

2}, Sara Bachmann Brenner^{1

3}, Marie-Anne Burckhardt^{1

3}, Melanie Hess^{1

3}, Jiafa Zeng^{1

2}, Alexandre N Datta^{1

3}, Urs Frey^{1

3}, Urs Zumsteg¹, Gabor Szinnai^{1

3}, Pablo Sinues^{1

2}

Affiliations

¹ University Children's Hospital Basel, Basel, Switzerland.
² Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
³ Department of Clinical Research, University of Basel, Basel, Switzerland.

Abstract

Purpose: This feasibility study aimed to investigate the use of exhaled breath analysis to capture and quantify relative changes of metabolites during resolution of acute diabetic ketoacidosis under insulin and rehydration therapy.

Methods: Breath analysis was conducted on 30 patients of which 5 with DKA. They inflated Nalophan bags, and their metabolic content was subsequently interrogated by secondary electrospray ionization high-resolution mass spectrometry (SESI-HRMS).

Results: SESI-HRMS analysis showed that acetone, pyruvate, and acetoacetate, which are well known to be altered in DKA, were readily detectable in breath of participants with DKA. In addition, a total of 665 mass spectral features were found to significantly correlate with base excess and prompt metabolic trajectories toward an in-control state as they progress toward homeostasis.

Conclusion: This study provides proof-of-principle for using exhaled breath analysis in a real ICU setting for DKA monitoring. This non-invasive new technology provides new insights and a more comprehensive overview of the effect of insulin and rehydration during DKA treatment.

Keywords: ICU; breath analysis; diabetic ketoacidosis; mass spectrometry; metabolomics.

MeSH terms

Adult
Aged
Biomarkers / analysis
Biomarkers / metabolism
Breath Tests* / methods
Diabetic Ketoacidosis* / metabolism
Feasibility Studies
Female
Fluid Therapy / methods
Humans
Insulin* / metabolism
Male
Middle Aged
Spectrometry, Mass, Electrospray Ionization / methods

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work is part of the Zurich Exhalomics project under the umbrella of the University of Medicine Zurich/Hochschulmedizin Zürich. This study was funded by the Fondation Botnar, Switzerland (Professorship to Pablo Sinues), and the Swiss National Science Foundation (Grant No. 320030_173168).